Cognitive and Psychosocial Benefit of Caregiver Training for Ugandan HIV Children

描述（由申请人提供）：研究主题：11万乌干达艾滋病毒儿童和100万未感染艾滋病的孤儿由于父母一方或双方患病或死于艾滋病，将得不到贫穷或不稳定的照顾（联合国艾滋病规划署，2006年）。因此，这些儿童的认知和社会发展可能在儿童早期受到阻碍，最终他们在学校的表现会更差。对敏感照顾者的调解干预（MISC）有一个结构化的课程和培训计划，向艾滋病毒母亲/照顾者传授每天在家中提高孩子认知和社会发展的技能。这是通过教导母亲/照顾者如何集中孩子的注意力，激发孩子的兴趣，扩大她的认知意识，鼓励她的能力感，并规范她在玩耍、喂食、洗澡和工作中的行为来实现的。为了使MISC适应乌干达的情况，并证明其在促进艾滋病毒儿童和孤儿的认知和社会发展方面的有效性，我们将使用一个由四部分组成的协议来评估父母培训项目：背景评估、投入评估、过程评估和产品评估（CIPP评估模型）。研究目标1是通过使用当地社区领导人、教师和护理人员的焦点小组，与我们合作，使MISC适应乌干达的环境，对MISC进行环境评估。研究目标2包括通过访谈和培训依从性对护理人员和家庭进行MISC培训的适当性和可接受性进行输入评估。研究目的3是通过家庭观察和家庭质量评估对干预的保真度进行过程评估，并通过录像带评估母亲/照顾者与儿童之间的照顾互动，以及照顾者自己的态度和方法在一年的培训期间的变化。研究目标4评估MISC培训的成果或效益；在马伦早期学习量表、幼儿注意警惕性测试（ECVT）、记忆颜色-物体关联测试（COAT）和儿童行为检查表（CBCL）方面，儿童在心理社会适应方面的进步。乌干达卡永加区120名感染艾滋病毒和120名未感染艾滋病毒的学龄前艾滋病孤儿中的一半的母亲/照顾者将被分配参加为期一年的每月以家庭为基础的MISC培训。其余儿童和照料者将继续接受每月定期的家庭保健探访。与未进行干预的儿童相比，HIV感染和未感染孤儿的MISC在Mullen学习、ECVT注意力和COAT记忆得分方面都有更大的提高。这些收益将通过每月看护录像样本的分数的提高来调节，这些分数被评估为MISC特征、家庭尺度家庭环境质量和基于家庭观察的儿童/照顾者质量相互作用（CCQI）分数。这些成果将因艾滋病毒儿童的临床稳定性而减缓。确定MISC护理培训的可行性和有效性将为资源贫乏环境中数百万受艾滋病毒影响的儿童提供一种增强认知能力的战略和可持续手段。除了儿童艾滋病毒感染对神经发育的直接影响外，考虑到艾滋病毒疾病如何进一步损害家庭环境质量和对已经贫困儿童的照顾，它对全球数千万艾滋病毒孤儿造成的公共卫生负担是巨大的。在非洲，为改善受艾滋病毒影响儿童的发展环境而开展的以家庭为基础的护理人员培训干预措施，可能是唯一最具发展战略、文化相关性和资源可持续性的手段，可使儿童免受艾滋病毒疾病的影响。更广泛地说，护理人员培训干预措施还可以增强所有面临贫困和其他公共卫生挑战风险的儿童的认知能力和心理社会适应能力，以实现联合国千年发展目标的第二个目标，即确保所有儿童都能够完成小学教育1。

DESCRIPTION (provided by applicant): Research Topic: 110,000 Ugandan HIV children and 1 million non-infected AIDS orphans will have poor or inconsistent caregiving because one or both parents are ill or dead from AIDS (UNAIDS 2006). Consequently, the cognitive and social development of these children may be stunted in early childhood, and eventually they will perform more poorly in school. Mediational intervention for sensitizing caregivers (MISC) has a structured curriculum and training program to teach HIV mothers/caregivers the skills for enhancing their child's cognitive and social development in the home each day. This is done by teaching mothers/caregivers how to focus a child's attention, excite a child's interest, expand her cognitive awareness, encourage her sense of competence, and regulate behavior during play, feeding, bathing and working. To adapt MISC to the Ugandan context and demonstrate its effectiveness for enhancing the cognitive and social development of HIV children and orphans, we will use a four-part protocol for evaluating parent training programs: context evaluation, input evaluation, process evaluation, and product evaluation (CIPP Model of Evaluation). Study Aim 1 is the context evaluation of MISC through the use of focus groups of local community leaders, teachers, and caregivers, partnering with us to adapt MISC to the Ugandan context. Study Aim 2 involves the input evaluation of appropriateness and acceptability of MISC training for the caregivers and household through interviews and training compliance. Study Aim 3 is the process evaluation of the fidelity of intervention though home observation and evaluation of HOME quality, and videotape evaluation of caregiving interactions between mother/caregiver and child, as well as changes in the caregivers own attitudes and approach throughout the year-long training period. Study Aim 4 evaluates the product or benefit of the MISC training; in terms of the child's gains on the Mullen Scales of Early Learning, the Early Childhood Vigilance Test (ECVT) of attention, the Color-Object Association Test (COAT) for memory, and the Child Behavior Checklist (CBCL) for psychosocial adjustment. Mothers/caregivers of half of 120 HIV-infected and 120 non-infected preschool AIDS orphans in Kayunga District, Uganda, will be assigned to monthly home-based MISC training for one year. The remaining children and caregivers will continue to receive the regular monthly home health care visits. MISC for both the HIV infected and non-infected orphans will lead to greater gains on the Mullen learning, ECVT attention, and COAT memory scores compared to non- intervention children. These gains will be mediated by improved scores on monthly videotaped caregiving samples evaluated for MISC features, HOME scale quality of home environment, and child/caregiver quality interactions (CCQI) scores from home-based observations. These gains will be moderated by clinical stability of the HIV children. Establishing the feasibility and effectiveness of MISC caregiving training will provide a strategic and sustainable means of cognitive enhancement for millions of HIV-affected children in resource-poor settings. Beyond the direct neurodevelopmental impact of pediatric HIV infection, the public health burden of HIV disease for tens of millions of HIV orphans globally is monumental when considering how it further compromises quality of home environment and caregiving for children already impoverished. In the African context, home-based caregiver training interventions to enhance the developmental milieu of HIV-affected children may be the single most developmentally strategic, culturally relevant, and resource sustainable means of buffering them from this impact of HIV disease. More broadly, caregiver training interventions may also enhance the cognitive ability and psychosocial adjustment of all children at risk from poverty and other public health challenges to the second of the UN Millennium Development Goals, which is to ensure that all children are able to complete primary schooling1.